Impact of SGLT2 inhibitors on blood pressure among kidney transplant recipients: insights from a French multicentric cohort (GREAT ASTRE).

Background: Blood pressure (BP) control remains a therapeutic challenge in kidney transplant recipients (KTRs). Sodium-glucose cotransporter-2 inhibitors (SGLT2is) lower BP in diabetic and chronic kidney disease patients. Whether this effect extents to KTRs remains to be fully established. We explored the BP lowering potential of SGLT2i, by examining their effects on BP and their influence on antihypertensive drugs prescriptions.

Methods: Using the French observational multicenter ASTRE database, we collected systolic BP (SBP), diastolic BP (DBP), weight and drugs, at baseline and at 3 and 6 months after SGLT2i initiation. To evaluate the impact of SGLT2i on other anti-hypertensive drugs management, we used metric such as the defined daily dose (DDD) and the hypertensive index (HTi).

Results: Two hundred thirty-four patients were included in the analysis, nearly all had hypertension and 63% had diabetes. By the 3-month mark, there was a significant 4 mmHg reduction in SBP and DBP, which was sustained at 6 months, with decreases of 2.5 mmHg and 3 mmHg (respectively for SBP and DBP). The DDD remained stable. HTi decreased by 14 and 9.5 points at 3 and 6 months, respectively. In multivariate analysis, female sex was associated with a more significant reduction in SBP and HTi.

Conclusions: In KTRs newly treated with SGLT2i, BP decreased at 3 and 6 months, while the overall antihypertensive load, as assessed by DDD, remained stable. Similar effects were observed on HTi. These findings suggest SGLT2i as an effective adjunctive therapy for lowering BP in hypertensive KTRs, regardless of diabetes status.